HOW IMPROVED DISCHARGE TIMES

CHANGED THE PATIENT EXPERIENCE…And everything else

Presented by: Chaise Camp, MBA, MA, MS, MA

chaisecamp@gmail.com

At a 200+ bed hospital located in North Carolina, we had some challenges we desperately needed to address.

First, patient satisfaction with the discharge process had seen virtually five consecutive quarterly declines.

Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15202530354045505560

33 3127 28

25 23

Perc

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e

??

Secondly, the average discharge time for Hospitalists’ patients was 3:40 in the afternoon. Patients were dissatisfied.

But there was hope. Analysis revealed that for every hour earlier a patient received their discharge order, that patient left the hospital an average 45 minutes earlier.

This piqued our curiosity.

What would happen if physicians rounded on likely discharges first?

Hospitalist leadership accepted the challenge. They would prioritize likely discharges in their morning rounds. As more Hospitalists joined in, discharge orders showed dramatic shifts to earlier times.

6:00

7:00

8:00

9:0010

:0011

:0012

:0013

:0014

:0015

:0016

:0016

:5917

:5918

:5919

:5920

:5921

:590%5%

10%15%20%25%30%

Aug May Feb

Time of Discharge Order

Perc

ent o

f Pat

ient

s w/ D

C or

ders

Since February, the mean Hospitalist discharge order time has fallen by 88 minutes. As predicted, the average time Hospitalists’ patients leave the hospital is falling in proportion.

FEB MAR APR MAY JUN JUL AUG10:59

12:11

13:23

14:35

15:47

12:4212:04 12:19

11:4311:22 11:28 11:14

15:4015:09 15:15 15:01 14:51 14:53

14:23

Hospitalist DC Order Time (Mean) Hospitalist Patient DC Time (Mean)

Tim

e of

Day

77 min. reduction

88 min. reduction

Comparing each month’s decline to our February baseline, we can calculate the number of hours saved for our waiting inpatients on discharge day. They really add up!

FEB MAR APR MAY JUN JUL AUG0

100

200

300

400

500

600

700

0

179 147

464 442483

620

Inpatient Hours Saved

Hour

s

2,336 Patient Hours Saved so Far!

Patient Satisfaction with the discharge process rose suddenly and dramatically as patients began leaving the hospital earlier on discharge day!

Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15202530354045505560

33 3127 28

25 23

51 49

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But the story doesn’t stop there…

The earlier discharge times meant inpatient beds became available to the Emergency Department earlier in the day. The ED’s time from bed request till the patient arrived on an inpatient floor fell by 50%.

FEB MAR APR MAY JUN JUL AUG50

100

150

200

250

300

350

400

155 155111

136109

72 78

Bed Request to Bed on Floor

Min

utes

77 min. reduction

As a result of this improvement and others, the total door to admit time for ED-admitted patients declined by an incredible 94 minutes!

FEB MAR APR MAY JUN JUL AUG50

100

150

200

250

300

350

400

155 155111

136109

72 78

369 362335 342

322275 275

Bed Request to Bed on Floor Door to Admit

Min

utes

77 min. reduction

94 min. reduction

The hours saved in the ED each month compared to February’s baseline is truly staggering! The 3,849 hours saved so far equates to 160 days worth of waiting for an inpatient bed.

FEB MAR APR MAY JUN JUL AUG50

100

150

200

250

300

350

400

0

200

400

600

800

1000

1200

1400

096

382 326

622

12531170

369 362335 342

322275 275

Time Saved for ED Admits Door to Admit

Min

utes

Hou

rs3,849 Patient Hours Saved so Far!

ED-admitted patients’ satisfaction with their ED care suddenly rose across every indicator.

Q1 '15 Q2 '15 Q3 '15 Q4 '150

1020304050607080

2127

68

49

1419

41 4334

19

72

59

1825

62

48

Courtesy of ER staff ER wait time before seen doctorER:kept inform re:condition/trtmnt Wait time in ER before admitted

Perc

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KEY TAKEAWAYS

• Keep a broad view of what drives the patient experience. It’s not just about hourly rounding and communication skills.

• Patient Experience departments must take a vested interest in operations.

• Our Hospitalist team broke with convention by rounding on likely discharges first (as opposed to sickest first). The improved throughput, from inpatient to the ED, made the whole hospital safer. It improved the patient experience and reduced staff frustrations.